Provider Demographics
NPI:1912336199
Name:MALHOTRA, DIVYANSHU (MD)
Entity type:Individual
Prefix:DR
First Name:DIVYANSHU
Middle Name:
Last Name:MALHOTRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6201 GREENLEIGH AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-2004
Mailing Address - Country:US
Mailing Address - Phone:410-933-6423
Mailing Address - Fax:410-500-4266
Practice Address - Street 1:600 N WOLFE STREET
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21264-3218
Practice Address - Country:US
Practice Address - Phone:410-955-5350
Practice Address - Fax:443-287-9854
Is Sole Proprietor?:No
Enumeration Date:2013-11-07
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME122471207R00000X
CT60348207RN0300X, 207RN0300X
MDD93619207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine